目的 探讨养老机构失智症照护人员道德困境的来源、体验及应对方式。方法 2024年11-12月,目的抽样法选取长沙市某养老机构的17名失智症照护人员为研究对象，通过半结构式访谈获取资料，采用内容分析法进行资料分析。结果 共提炼出3个类别：道德困境的来源（失智症症状相关行为与理想照护实践的冲突、家属主导决策与专业照护理念的冲突、照护人员专业知识与实践经验不足、人力资源与时间资源不足），体验（失智症照护人员的情绪内耗与自我效能感下降、负性情绪传递与护患关系受损、组织氛围恶化与机构声誉受损）及应对方式（寻求社会支持与积极自我调适）。结论 养老机构失智症照护人员的道德困境成因多元、影响广泛；建议通过优化决策机制、加强专业培训、提升道德韧性并完善组织支持体系，以缓解其道德困境，提升照护质量。

Objective To explore the sources,experience,and coping strategies of moral distress among dementia caregivers in nursing homes.Methods From November to December 2024,a purposive sample of 17 dementia caregivers from a nursing home in Changsha was recruited.Semi-structured interviews were conducted,and data were analyzed using content analysis.Results 3 categories were extracted: sources of moral distress (conflicts between dementia-related behavioral symptoms and ideal care practices,conflicts between family-dominated decision-making and professional care concepts,insufficient professional knowledge and practical experience among caregivers,and inadequate human and time resources);experience of moral distress (emotional exhaustion and decreased self-efficacy among dementia caregivers,transmission of negative emotions and impaired nurse-patient relationships,and deteriorating organizational climate and damage to institutional reputation);coping strategies (seeking social support and positive self-adjustment).Conclusions The causes of moral distress among dementia caregivers in nursing homes are multifaceted and have widespread impacts.It is recommended to alleviate moral distress and improve care quality by optimizing decision-making mechanisms,strengthening professional training,enhancing moral resilience,and improving organizational support systems.

R473.59

湖南省自然科学基金 (2024JJ5484)；湖南省财政厅省补助卫生健康项目(湘财社指[2024]31号)